Diagnosis and management of massive vitreous hemorrhage caused by retinal tear

Fourteen cases of massive vitreous hemorrhage caused by a retinal tear, the cause having been confirmed during closed vitrectomy, were studied retrospectively. In the 3 cases with no retinal detachment and in the 6 cases with partial but not extensive retinal detachment at the time of surgery, the electroretinogram (ERG), visual evoked response (VER) and electrically evoked response (EER) were recordable preoperatively. After surgery the retina was attached in all 9 cases, but later redetached in one case. The visual acuity improved in 8 of the 9 cases. In the 5 cases with subtotal or total retinal detachment at the time of surgery, the ERG was nonrecordable preoperatively in all 5 cases, while the VER and EER were recordable in 4 cases. After surgery the retina was reattached in 3 of the 5 cases, but later redetached in one case. Visual acuity improved in only 2 of the 5 cases. When a retinal tear is suspected to be present, surgical intervention should not be delayed in cases of massive vitreous hemorrhage which does not clear after initial bilateral patching and bed rest. Ultrasonographic and electrophysiological tests help establish the diagnosis and prognosis.